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April 25, 2017

Vascular Dementia (VaD) is the second most common form of dementia in older adults after Alzheimer's disease (1,2). The term refers to a group of syndromes caused by different mechanisms affecting the blood vessels in the brain and resulting in vascular brain lesions. These lesions can be imaged and visualized using different imaging modalities such as MRI or CT.
VaD and Alzheimer's disease are not mutually exclusive, and in fact often coexist in the same patient (a situation known as mixed dementia).
VaD usually affects people between the ages of 60-75 and is more likely to occur in men than in women. There is a link between stroke and VaD as some cased of VaD are actually caused by a series of small strokes.  High blood pressure, one of the main reasons for stroke is actually an important risk factor for VaD.
About 1.5% of people in North America and Europe suffer from Vascular Dementia, and in Asia the disease prevalence is even higher, reaching 2.2% in Japan. By 2030 the number of VaD patients in the USA is expected to reach 2 million (3). The incidence of dementia is 9 times higher in patients who have had a stroke than in the general population. One in four stroke patients will develop new-onset dementia within a year of their stroke. The relative risk of incident dementia is 5.5% within 4 years of suffering a stroke.
The NIH lists the following symptoms as potential indications for VaD:

    - Confusion and problems with recent memory
    - Wandering or getting lost in familiar places
    - Moving with rapid, shuffling steps
    - Loss of bladder or bowel control
    - Laughing or crying inappropriately
    - Difficulty following instructions
    - Problems handling money

Treatment of VaD is currently limited to administering antiplatelet drugs and controlling risk factors such as hypertension, hypercholesterolemia, smoking and diabetes mellitus. The costs associated with treating VaD patients are high. In a recent report from Spain these costs were estimated as 22,000 Euro per patient per year on average (4).

References:

1. http://www.nia.nih.gov/Alzheimers/Publications/dementia.htm
2. http://en.wikipedia.org/wiki/Multi-infarct_dementia
3. Bachman DL, Wolf PA, Linn RT, et al. Incidence of dementia and probable Alzheimer's disease in a general population: The Framingham Study. Neurology 1993;43:515-519
4. Sicras A, Rejas J, Arco S, et al. Prevalence, resource utilization and costs of vascular dementia in a population setting. Dement Geriatr Cogn Disord. 255;19:305-315

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